<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Dx_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dx_date" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[dx_date]" type="text" value="{$row.dx_date}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhichu_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhichu_money" class="form-control" step="0.01" name="row[zhichu_money]" type="number" value="{$row.zhichu_money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhichu_remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-zhichu_remark" class="form-control " rows="5" name="row[zhichu_remark]" cols="50">{$row.zhichu_remark|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouru_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shouru_money" class="form-control" name="row[shouru_money]" type="number" value="{$row.shouru_money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouru_remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-shouru_remark" class="form-control " rows="5" name="row[shouru_remark]" cols="50">{$row.shouru_remark|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouli_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shouli_id" data-rule="required" data-source="shouli/index" class="form-control selectpage" name="row[shouli_id]" type="text" value="{$row.shouli_id|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
